Lab 2 . Part 5 - How to Tie Knots

Basic Steps

Position model so incision is vertical and yellow strand is to the left of incision

Needle holders are held in the dominant hand

Surgeon's Throw

1. place needle holders on the incision
2. wrap the tip of the needle holders around yellow strand TWO TIMES
3. grasp end of blue strand with needle holders
4. pull blue strand to left 
         yellow strand to right
5. tighten both strands with even tension keeping hands down near “patient”

Second Throw

1. place needle holders on incision
2. wrap needle holders around yellow strand ONCE
3. grasp end blue strand with the needle holders
4. pull blue strand to right
         yellow strand to left
5. tighten both strands with even tension keeping your hands down near the “patient”.

Third Throw

• place needle holders on incision
• wrap needle holders around yellow strand ONCE
• grasp blue strand with needle holders
• pull blue strand left
        yellow strand right

Additional Throws

1. continue to alternate the throws (without the double wrap) until sufficient numbers have been placed to achieve a secure square knot (usually a total of 5-6 times)
2. check that each throw and your completed knot is “square” and the ends lie flat

Detailed steps of left handed one hand tie

• Position suture in the “tissue” as if the incision is horizontal and you are suturing towards yourself

• to make it easier to follow the video, position the blue strand on top and the yellow strand on the bottom

First throw

1. lay the blue suture over the open palm of your right hand
2. close the last 3 fingers (middle, ring and baby) over the strand
3. make a gun with the index finger and thumb
4. tuck the gun under the blue strand
5. pick up the yellow strand with your left hand
6. place blue strand between thumb and index finger to make a circle with the right index finger inside
7. thread the index finger over the yellow strand and then under the blue strand
8. flip the blue strand through the center of the circle and pull it downwards while pulling the yellow strand upwards

Second throw

1. hold the blue strand with the thumb and index finger of the right hand
2. place remaining 3 fingers (middle, ring and baby) on top of the blue strand
3. roll your fingers over
4. with your left hand, lay the yellow strand beside the blue strand to make a circle with the 3 fingers inside
5. thread your middle finger over the yellow strand and under the blue strand
6. flip the blue strand through the center of the circle and pull it upwards while pulling down on the yellow strand

• steps are alternated until sufficient throws have been placed to form a secure square knot

• NOTE: Can begin knot with either throw depending on where the needle is and how the suture is positioned in the tissue

• make sure when you start your hand tie that there is only one circle (not two) or you will have to cross your hands when tightening.check that each throw and your completed knot is “square” and the ends lie flat

  • if there are two circles, change the strands in your hands or start with the other throw

Detailed steps

• position suture in the “tissue” as if the incision is horizontal and you are suturing towards yourself
• to make it easier to follow the video, have the “yellow” strand on top and the blue strand on bottom

First throw

1. Lay the yellow strand over the open palm of your left hand
2. Close the bottom three fingers (middle, ring and baby) over the strand leaving your index finger under the yellow strand
3. With your right hand, pick up the blue strand and cross your index finger
4. Pinch your left thumb and index fingers together
5. Dive into the circle and from underneath pinch the blue strand
6. Dive out of circle bringing the blue strand with you
7. Grasp the blue strand with your right hand
8. Pull the blue strand up while pulling down on the yellow strand

Second throw

1. Continue pulling down on the yellow strand with the bottom 3 fingers of your left hand
2. Tuck your thumb under the yellow strand and bring your thumb over the incision
3. Cross your thumb with the blue strand held in your right hand
4. Pinch your left thumb and index finger together
5. Dive into the the circle and pinch the blue strand from underneath
6. Dive out of the circle bringing the blue strand
7. Grasp the blue strand with the right hand and pull it down while pulling upwards on the yellow strand

• alternate steps until enough throws have been placed to achieve a square knot
• check that each throw and your completed knot is “square” and the ends lie flat

Detailed steps

• position suture in the “tissue” as if the incision is horizontal and you are suturing towards yourself
• to make it easier to follow the video, position the blue strand on top and the yellow on the bottom 

First throw

1. Lay the blue strand over the open palm of your right hand
2. Close the bottom three fingers (middle, ring and baby) over the strand leaving your index finger under the blue strand
3. With your left hand, pick up the yellow strand and cross your index finger
4. Pinch your right thumb and index finger together
5. Dive into the circle and from underneath pinch the yellow strand
6. Dive out of the circle bringing the yellow strand
7. Grasp the yellow strand with your left hand
8. Pull the yellow strand up while pulling down on the blue strand

Second throw

1. Continue pulling down on the blue strand with the bottom 3 fingers of right hand
2. Tuck your thumb under the blue strand and bring your thumb over the incision
3. Cross your thumb with the yellow suture held in your left hand
4. Pinch your right thumb and index finger together
5. Dive into the circle and pinch the yellow strand from underneath
6. Dive out of the circle bringing the yellow strand
7. Grasp the yellow strand with your left hand and pull it down while pulling upwards on the blue strand

• alternate steps until enough throws have been placed to achieve a square knot
• check that each throw and your completed knot is “square” and the ends lie flat